Anesthetizing apparatus



June 22, 1937. w. R. HENION ANESTHETIZING APPARATUS Filed NOV. 25, 19524 Sheets-Sheet l I NVENTOR WALTER F1.HEN10N WZi/F, ATTo Rlvfiya June 22,1937. WQR. HENION ANESTHETIZING APPARATUS Filed Nov. 25, 1932 4Sheets-Sheet 2 INVENTOR .4 TTORNEYS- June 22, 1937. w. R. HENIONANESTHETIZING APPARATUS Filed Nov. 25, 1932 4 Sheets-Sheet 3 INVENTORWALTERRHENION 5'19 P A-r-ronwzys Patented .June 22, 1937 UITED STATESPATENT OFFICE to .The Heidbrink Minn., a corporation Company,Minneapolis, of Minnesota Application November 25, 1932, Serial No.644,219

37 Claims.

This invention relates to improvements in anesthetizing apparatus and isparticularly concerned with means operable by the patient to keep thepatient in a state known as analgesia,

r in which consciousness 'is maintained but no pain is felt. Thecondition resembles twilight sleep in which the patient cannot feel painbut retains voluntary motor ability, The present de--' vice is useful inobstetrical cases.

The invention takes advantage of the reflex and/or voluntary grippingtendency of a person in pain, this gripping tendency being due tonervous tension. In the present devicejas gripping progresses, more ofthe analgesic substance is delivered to the patientfor breathing, and asgripping is lessened, less is delivered.- On the other hand by thisdevice, an anesthetic substance can be delivered or shunt oifindependently of the patient and while the patient continues to grip thecontrol.

An important feature of the invention is gripping action by the wholehand, as distinguished from the, pressing of a button or the pressure ofa control device held between the thumb and forefinger. There is atendency for a person in pain, for example when in the dental chair, to

grip the arms of the chair and this natural gripping action while thearms rest on the chair or on the arm of the chair is taken advantage of.

I am aware that there have been some devices which purport to properlycontrol analgesia but, insofar as I am aware, no one has ever produced areally practicable device by which the patient can himself successfullymaintain the proper condition of analgesia.

The present device provides means whereby there are, when the patient isbreathing air, no back pressures in any part of the mask or in thebreathing tube. The device further provides means whereby the flow ofanalgesic substances is automatically stopped before the patient becomesunconscious-and provides means whereby breathing of atmospheric air maybe had, without removal of the mask and without removal of any part ofthe apparatus. In this device, the

analgesic agent may be at, all times under the control of the patientand immediately the flow of anesthetizing agent is stopped, air can bedrawn through the breathing tube only under atmospheric pressure.

The device can be used as an attachment on any type ofljmachine, or canbe incorporated as an integral part of any type of machine either formachines of continuous flow type or of the intermittent flow type.

Features of the invention include means for controlling analgesia by thegripping action of the whole hand; the delivery of exhalation of thepatient at a point remote from the patient and operator; the control ofdelivery, breathing bag, and air intake passages, by a single valvemeans; means for by-passing gas around the valving means; the deliveryof this by-passed gas into the breathing tube at a point remote from theair intake opening; means adjustable by the operator for obtaining asupply of analgesic substance after the patient has closed the maindelivery valve; means for varying the timing; means for delivering anadditional quantity of anesthetizing substance during the timing period,and all details of construction and arrangement of the parts, asdisclosed.

Objects, features and advantages of the invention will be set forth inthe description of the drawings forming a part of this application, andin said drawings Figure 1 is a side elevation of the apparatus of thisinvention;

Figure 2 is a, top plan;

Figure 3 is a vertical lonigtudinal section through the valve-controlledgas delivery portion of the machine, taken approximately on line 3-3 ofFigure 2;

Figure 4 is a plan section taken approximately on line 4-4 of Figure 3,but with the valve means moved to a control position opposite that shownin Figure 3;

Figure 5 is a fragmentary vertical section corresponding to Figure 3,but with the valve means releasably locked in the position shown inFigure 4;

Figure 6 is a side elevation illustrating the device as an attachmentfor any suitable type of machine for delivering anesthetizing substance;

Figure 7 is a vertical section on line 1-1 of Figure 2, illustratingauxiliary pressure regulation means;

Figure 8 is a vertical section through the pressure regulator andrelated parts, taken on line 8-8 of Figure 2; and

Figure 9 is a vertical section taken on a line corresponding to that ofFigure 3, illustrating means for timing an extra supply of anesthetizinggas after the patient has sufiiciently lessened the grip of the controlelement to stop delivery of anesthetizlng substance.

Numeral l indicates the top portion of a floor standard acting as asupport for the apparatus. Mounted on the standard is a frame structureincluding various tubular members forming'pasof this structure includesthe yokes 2 which may be of any preferred form, which support the gascontainers. Pairs of yokes are generally provided, two for containers ofnitrous oxide, for example, and two for containers of oxygen. In regardto the major features of this invention, there is no intention to limitit to any particular type of anesthetizing apparatus. Moreover, onlythose parts of the apparatus have been shown in the drawings, in detailor otherwise, which seem essential to the understanding of the functionsinvolved in this general class of machine.

The gas containers have not been shown. Referring to Figures 2 and 8,the passage into which the gas is delivered from the gas or vaporcontainer (held in the yoke) is indicated at 3. This passagecommunicates with pipe 5 which communicates with horizontal passage 5,which connects with passage 6 to the pressure regulating device,generally indicated at 8 and ofgany preferred form. In this case, thereare two of these devices, one to regulate the oxygen and. one toregulate the nitrous oxide. The valve mechanism for this pressureregulator includes a piston-like valve l which is part of yoke iiattached to diaphragm l2. The diaphragm is adjusted by spring 13, thecompression of which is controlled .by the usual means. When thisadjustment takes place, the element i0 is raised or lowered, as apiston, against the action of the spring M which acts in opposition tothe spring l3, and moves the valve l0 to seating position.

The valving washer i cooperates with the end of a plug or seat Hi tocontrol passage ll communicating with the passage 6. The gas escapespast the valve into chamber 20 and thence into a passage indicated indotted lines at 2! which, in Figure 8 of the drawings, is at the's'amelevel as the passage 6 and appears at the center of the figure. Thispassage 2i is also indicated in dotted lines in Figure 2. The gas, afterpassing through the regulator, enters the passage 2| and from thispassage is delivered into-passage 22, see also Figure 7. The passage 22is formed in a cross arm 24, and this passage islin communicationthrough tube 25 with a suitable pressure gauge indicated at 26, see alsoFigure 1. There are two of these pressure gauges, one for oxygen and onefor nitrous oxide, and they may be of any suitable construction,,and,therefore, have'bee'n only diagrammaticallyrepresented in the drawings.The gauges indicate pressures corresonding. to regulator adjustments.The passage 22 is constricted as at 21 and leads into an annular mixingchamber 28 (see also Figure 3) from which chamber it is deliveredthrough-ra-' dial passages 29in plug 30 .into an axial passage 3| of theplug. The plugis in threaded engagement with atubular member- 32 havingpassage 33 leading forwardly, see also indotted lines in Figure 2. Thispassage is designated herein as the delivery passage for the mixed orunmixed anesthetizing fluid or gas or vapor, or oxygen. The course ofthe fluid has only been traced for one side of the machine. The coursefor the opposite side of the machine is substantially identical. It willbe understood that gases of difierent kinds can be delivered fromopposite sides of the machine to the annularchamber 28, where theyare-mixed, and whence they are delivered into delivery passage 33. Thearrangement or position of the passages of the machine, and of I thevarious controls, are features of the invention.

' Referring to Figure 7, which is a section on line any type of machineis important.

aoeasoa sages for the anesthetizing fluid. The lower part 'ii of Figure2: Each passage 22 leading from the regulator to the mixing channel 28is provided with a needle valve 23 operable for adjusting the flow ofthe gas in a manner to compensate for pressure gauge inaccuracy. Eachvalve seats inthe end of the corresponding restricted passage 2l. Thisis a feature of the invention.

An important feature of this invention relates to the control by thepatient of the delivery of the anesthetizing or analgesic substance fromthe'passage 33 to the inhaler. The construction now to bedescribed maybe an integral part of I the new machine, above described, or it may bean attachment, and its use as an attachment for In Figures 1, 2 and 3,it is shown as an integral part of the machine, while in Figure 6 it isshown as an attachment which may be connected to the delivery passage 33(or equivalent passage) of any machine .of the general class previouslydescribed.

Another feature of the invention relates to a patient-controlled meansinterposed in the breathing line between the point of delivery of thegas supply and the patients nose, and performing three functions, towit: control of gas which a breathing tube 38 is attached, and a pas-.

sage 39 in extension 40, the extension being provided for .theattachment of a breathing bag M. The passage 36 is formed in a. tubularextension d2, but it will be understood that this extension may bedispensed with and the casing may simply have an opening-at thepoint43.- The inhaler or mask is indicated at 38?. tube connectsf'it' withthe -=tube 38, but tube 38 may be connected directly to elementfl38 andsuch a connectionismhntemplated herein,

valvejmeans, controllable .by the patient ina manner hereinafter to bedescribed, is provided for simultaneously controlling the delivery ofgas or anesthetizing substance from delivery passage 33 through thepassage in the fitting 45 into the chamber 35, controlling entry of thegas through the bag passage 39, and controlling entry of air into thechamber 35 through the passage 36.

The invention also contemplates the separate con- ."trol of any twoofthese passages, for example i the delivery and air intake passagesonly.

- motion being controlledby a plunger 48 slidable in the casing and ,s'uitably connected to control wire 49, which wire passes through a tubularmember 50 rotatable uponxextension 5| of the casing 52 in which thech'a'mber'35 is formed. The wire passes through a. section of flexibletube 53, see Figure 3, and thence through a metal This chamber a: Theusual double (or flexible) tube and into the tubular portion 1 I 57 of ahand grip element 58, seeFigure 1'. This tubular portion is suitablysecured to' a handle or grip section 58 which has somewhat the form ofthe grip of an automatic-pistol. The element 58'may represent the arm ofa, chair in a grooveof which the trigger, or button Gil-is pivoted,v or;with which 'arm it is operably attached many suitable manner. Thepositioning of this trigger the fingers.

or its equivalent in any way on the arm, is a feature.

The end of the control wire 49 is attached to a lever or trigger 60suitably pivoted to the grip section 58. This trigger normally, asbefore gripping by the patient, stands in the position shown, andsuitable depressions 6| are provided to receive This form of grip is avaluable feature of this invention inasmuch as it takes advantage of thegripping action of the entire hand to control the delivery of theanesthetizing agent. An important object is to produce and maintain acondition of the patient known as analgesia, in which there is a loss ofsensation to pain, without total loss of consciousness, and in whichvoluntary motor ability is retained. It will be understood that thisidea of utilization of the gripping action of the entire hand, or morethan two fingers, particularly as distinguished from control by means-of the thumb and forefinger, can be applied to the arm of a dentalchair, for example, which arm the patient generally naturally grips whenin pain.

When the trigger 60 is moved in the direction of the arrow, the valvemeans is moved (see Figure 4) to admit anesthetizing substance to 'thebreathing tube and to the bag, and to close the air intake passage. Whenthe trigger 60 is in the position shown in the drawings, the valve meansis in the position shown in Figure 3, in which no gas can enter thechamber 35, nor the bag passage 39, and in which the air passage is openso that air may pass through chamber 35 into the passage 3? and into thebreathing tube which, designated 65, controls passage 55, and

the other of which, 66, alternately controls bag passage 31- and the airintake passage .43, these valves being movable in unison. Spring 67keeps .65 and/move the valve 66 from the valve element 66 against thebottom surface 68 out of the chamber to maintain a seal, the springbeing carried in a tubular member which is pivoted to the casing 52 asat 69. Spring automatically moves the frame to the position shown tocause the valves to close the gas delivery and bag passages, andthegripping action of the patient is exerted against'the' action of thisspring to move the frame to. open the valve its position over the airintake passage 36.

The

'. bottom.end of the tube is forked and engages to that shown by thearrows.

rection. It is obvious that when the'patient moves the element ,60 inthe direction'of the arrow, the frame correspondingly moves, spring l2acting to pull the tube to move the valve, which then moves to theposition shown in Figures 4 and 5, in which position anesthetizing gasis delivered to the patientand air entry is prevented. Upon release ofthe grip and its movement to the position shown in Figure 1, the spring10 acts to move the frame in a direction opposite Stop [it limits motionof valve 66 to a position over the air intake 36 or 43. Frame 41 is, ofcourse, suitably slidably guided. After the valve 66 passes across I avertical line passing through pivot 69, the valves are snapped to theposition toward hich thev end of the tube 40.

are traveling. Spring 6|"|| acting inone direction, and springs 61-12acting in the other direction.

Another feature of this invention is the means whereby the valve meanscan be locked in the position shown in Figures 4 and 5. This isaccomplished by grasping the tube 50 and pulling in direction of thearrow. The result is that the tubular member 50 is pulled ofi of theextension 5|, whereafter it is made to assume the position shown inFigure 5 in which its end 16 abuttingly engages the outer end 18 of theextension 5|. This releasably locks the valve means in a position toclose the air intake passage 43 and open the chamber 35 and the bagpassage 39 to a supply of anesthetizing substance. Of course, the tube56 could also be flexible, and could act as a conduit for conductors forthe electrical operation of the valve means, by means of a button on thearmof the dental or other chair.

When the control is used as an attachment for any machine which has abag, the bag passage 39 may be closed by a suitable cap not shown.Referring to Figure 6, which shows .the attachment applied to thedelivery passage of a machine of the bag type, the delivery passage isdesignated 80, the bag passage or tube 8|.. In this case, the tube 8| isclosed by a cap 82, but when it is desired to attach the bag to themachine, the cap 82 is removed and the bag slipped over the tube, theseparts generally having a friction fit. The cap 82 is'inte'rchangeableand is then placed over the Of course, in case of transfer of the bagfrom 40 to 8|, there will be no control of the bag opening by thepatient-controlled valve means. The bag may, in some instances. bedispensed with.

.- Bil-pas Another feature relates to means by which gas from eitherfsupply carboycan be directly introduced into the breathing tube, withoutpass ing through the main delivery passage 33. Th s feature is referredto herein as by-passing. Gas, either N20, or oxygen, or both, may beby-passed, andg'for this purpose, pipe connections are made with chamber20 of each regulator, see Figures 1, '2 and 8, as at 85 leading bysuitable pipes and connections, including unions and pipes 681 8B, tocommon passage 89 (Figure 3) ,vvhich, in turn, delivers into pipe 9il towhich ."flexible breathing tube 9| is attached. Thi l t- Springs ii-I2are each attached at one end 5 S a to theframe 41 and each at itsopposite end is.: attached to'the tube containing spring 51.

ter tube delivers into flexible breathing tube 38 at a point relativelyremote from the chamber 35 and valving means therein, and, therefore,remote .-from the bag opening 39 and air intake passage 35. Each pipe 88has a valve 92. By this means,

" when desired, any amount of' gas may be delivered independently of anycontrol by the patient and at the will of the anesthetist or operator.By this means also, either oxygen or ananesthetizing gas or vapor can beby-passed to the patient.

During by-passing, the by-pass valve for the anesthetizing gas is (whenthe patient is gripping) opened and gases are delivered'from twosources, to wit: a mixture of N20 and oxygen by the main valve and someextra N20 through th I by-pass.

It is noted that the point of delivery of'gas,

intake passage-or main delivery point.

A suitable safety valve is provided for each The valve of the bypass isgenerally adjusted to supply a lesser or greater quantity of gas than isnormally delivered through the main valve or passage 33.

When the by-pass feature also lay-passed so that gas is shot directlyand quickly to the patient without mixture in the bag. With the by-passthe patient cannot entirely out ofi the anesthetic gas. Although he canclose the main supply valve from the machine to the chamber, the"by-pass continues to deliver to, or into, the inhaling tube. However,when he does close the main valve, he getsa mixture of air, as before,theonly result being that he cannot get as much air as he wishes, as inthe construction of Figure 3.

Timing Another feature of the invention relates to meanswhereby thevalve means can be independently controlled to continue delivery ofanesthetizing substance for a timed period, after operation-of the valvemeans by the patient to stop delivery of such substance. This isnecessary in some instances where the operator or doctor believesthatthe patient is not capable of making proper judgment as to when thesupply of anesthetizing substance should be stopped. One form of.device, for performing this function is best shown in Figure 9, which isa vertical longitudinal section. This device may be an attachment forany suitable machine, or may be an integral part of such-machine.

The rod 48 has a yoke 95 pivoted to a sleeve 96 slidable on a piston rod91 having a piston head 98 operablein cylinder 99,. which cylinder issecured to the wall of the casing 52 within chamber by means of two pipeconnections respectively indicated at I00 and IM and a fastening deviceor devices IOIas A spring I02 acts to move the piston to the positionshown, against the gripping action of the patient, which gripping actionmoves the rod 91 in the direction of the arrows. The piston and cylinderconstitute timing means.- When the piston is moved to the right from theposition shown, as the result of gripping action of the patient, airenters the cylinder through check valve I03. When the patient releasesthe grip, the piston travels under the action of spring 92, against airpressure toward the left, and its speed is regulated by the exit of airpast needle valve I05. By means of this valve, the timing period can bevaried.

In order to release the rod 91 so that timing may be had independentlyof any control by the patient, the following means is provided: The rod91 is notched as at I06 and this notch is engaged by a verticallyslidable pawl I01 held yieldably in engagement with the notch by springI08. At the top of the pawl is provided a cam I09 which can engage atrip pin IIO, the position of which can be, moved by rotation, by meansof a set lever, to non-tripping position, When the stroke limit isreached during travel of the patient-controlled element'48 to the right,the cam I09 engages the.

trip H0 and the detent is disengaged from the notch I06 and the pistonrod is released, to travel shownwhen the patient sufliciently releasesthe grip. The gripping action of the patient is against that of thespring 'I I2, as well as against the acaoeaecm tion of thespring I02. Ontripping of the pawl, the patient continues to grip the control againstthe action of the spring II2, but as soon as the grip is released, thespring H2 acts to bring the collar to the initial position shown inFigure 9,

. Whereat the pawl assumes locking position. is used, the bag is of setscrew III. Piston rod 91 and rod H6 move together. This rod forms partof the valve means and has a sealing fit in cylinder IIB, the innerdiameter of which cylinder is greater than the outer diameter of the rodto provide a passage to receive delivered gas or vapor. The rod H6 isprovided with a gas delivery passage II9 which opens into the chamber 35at I20. The element II i has a foot portion I2I which abuttingly engagesa valve I22 which is the functional equivalent of the valve 66 andalternately controls the passages 39 and 43. The valve I22 is pressedagainst the surface I23 of the casing 52 by means of a device generallydesignated I25 which is the functional equivalent of thedevice 6'l69 ofFigure 3. The valve I 22 is moved to the position shown by action ofspring I26.

During motion of the valve I22 in direction of the arrow or to the rightby means of the foot IZI of the yoke I I4, and as the parts reach theirlimit of motion, a latch I21 engages a projection I28 of the valve tohold the valve over the air intake opening43 until the end of the timingperiod, that is during the time that the motion of the parts moves in adirection opposite the arrows or to the left. At the end of this period,a trip I29 engages a camming surface I30 of the is then moved to itsinitial position by means of the spring I26, to abut the foot I2I.

' The valving means may be modified to control only the passage 45 andthe air intake passage 43, as previously mentioned in relation to theform of the invention shown in Figure 3. It will be understood that theintention herein is to cover control of either a two or three orificevalve means by the gripping on the part of the patient.

It is to be noted that the reciprocable valve bar H6 projects beyond thecasing 52 whatever its position, so that the operator or doctorcan seeit at all times. After the bar is moved to its extreme position to theright (main delivery valve open) and as the bar moves in the oppositedirection during the timing period, the doctor can judge by the lengthof the projecting por-' tion of the bar, the stage of the timing period.It is further noted that by fully opening the valve I05, the timer canbe rendered inoperative.-

During timing, breathing and rebreathing takes place in the bag, and iscontinuous throughout the timing period because valve I22 is released bylatch I2'l only at the end of that time period. The important point isthat the patient cannot breath air during this period becausevalve I22is held in a position to close the air intake passage, and is releasedto close the bag opening only at the end of this period.

When the timer is used the speed of the pa.- tients recovering fromanalgesia is lessened and this timing is resorted to because the patientmay be of a typewhq will not maintain the grip long enough to maintainanalgesia over a period as long as the doctor thinks is necessary, andthis scheme enables the doctor to deepen or continue pawl, to raise itand release the val e I22 which analgesia and, tnerefore, to obtain afiner or more accurate control of analgesia, conformably to the type ofpatient.

Means for increasing the amount of gas during timing period Anotherfeature of the invention relates to means for increasing the amount ofthe delivered gas during the timing period, so that the patient will forthe relatively short timing period, be made to breath more analgesic gasfor this shorter period; or a greater volume of gas can be delivered,whether the timer is operative or not. To this end, a valve I43 controlspassage I44, leading from the chamber H8 in communication with the gasdelivery line 45, when the valve 65 is opened. A suitable hand lever I45at the outside of the case controls this valve. An automaticallycontrolled auxiliary valve I46 controls delivery of gas into the case 35after passage through the valve I45. This latter valve I46 is attachedto one arm I41 of a lever suitably pivoted as at I49 to the cylinder H8.

The opposite end of the lever passes loosel I5I raises the lever toclose the valve I46. 010-. sure is initially prevented, however, bymeans of detent I53 pivoted within the slot I50 as at I54, said detentengaging a stop I56. During motion of the element II4 to the right fromthe position shown, the detent is moved away from the stop in thedirection of the arrow to release the lever and obtain closure of valveI46, and rides upon the top of the lever and reaches the downwardlyofi-set portion I51. On return movement of the element H6, that isduring the timing period, the detent I53 engages the stop and ridesalong the upper surface of the lever in a manner to open the valve I46or move it to the initial position shown. An extra amount of gas is,therefore, delivered through the orifice I44 during the timing periodand until valve 65 closes.

The timing mechanism is so constructed that timing can be controlled bythe patient or can be controlled entirely independently of the pa- Itient, according to the position of the element H0. When the supportcarrying element is rotated so that IIO lies sufiiciently below thelevel shown, I09 does not engage it and no tripi0 ping takes place, butthe elements 48 and 91 remain coupled. Automatic control independentlyof the patient is, of course, obtained as the result of the cam I09engaging the trip I I0. The position of the trip is changed by rotatingits sup- ;5 port by means of the lever shown in dotted lines.

The lever has a suitable handle and a translatable locking pin, notshown, which can be engaged with either one of two openings of thecasmg.

intake passage to prevent loss of anesthetizing gas to the atmosphere,during a by-pass period, that is after the patient has released his gripto close the main valve. This device is illustrated in :5 Figure 1 andcomprises cylindrical elements I60 and I M telescopically engaged sothat the volume of the chamber can be changed, in this instance bysliding the lower cylindrical section I6I vertically relative to theelement I60. The element 7 I60 has a removable friction fit with thetube. 42 and carries a rod I62, which rod slidably passes through across piece I63 carried at the top of the cylindrical element I6I. Ahead I64 on the rod limits downwardlmovement of the element 75 I6I. Atthe. bottom of the element I6I'there is through a slot I50 in the yokeH4 and a spring he removes the inhaler.

Means is providedandassociated with the air anair intake opening I66andabove this opening, in spaced relation, is placed a guard I61. A valveplate I60 is arranged to control the opening I66, the plate beingpivoted at I69 and having a handle. The volume is so adjusted as tocatch only that volume which the operator judges the patient shouldbreathe. This receptacle can be used with the timer, and by-passfeatures, and is useful for lessening waste of gas or gases.

After closure of the main gas supply the patient is breathing by-passgas back and forth through the chamber, by means of passages 36I66.Under these conditions, part of the anesthetizing gas is trapped at eachexhalation, and through this trap gas air is i i-breathed. As theresult, of course, there is a mixture of air and gas in the chamber andin the breathing tube. If the chamber were not used, a substantiallygreater amount of anesthetizing gas would be lost to the atmosphere.

When using the by-pass; gas delivery continues after closure of the maindelivery valve. With the timer, and also when the valve I46 is used, allgas is stopped after such timed closure. Of course, the by-pass featuremay be used with the timing feature, and the machine can be used foranesthesia or analgesia. By-pass gas cannot be stopped by the patient ortimer.

The regulator is set to deliver more than would normally be deliveredfrom orifice I20 which orifice is smaller in caliber than passage II9.

When the device is used as an attachment shown in Figure 6, the by-passpipes 86 are each provided with a union I40 which is adapted to beattached respectively to the oxygen and gas delivery pipes of any typeof machine. The means by which the attachment is completed to thedelivery pipe 80 is herein shown as a union nut I4I.

Another feature is that the cross-sectional area of the air intake isalways equal to, and can be greater than, the corresponding area of thebreathing tube so that the patient can substantially immediately get asupply of air. In most of the devices with which I am acquainted, theair intake or exit orifices are so small that free exhaling is notobtainable and the patient immediately senses this condition and isfearful that he cannot get' enough air, or cannot getit when he wantsit. I

At present, indentistry, there is no means by which the patient canproperly control analgesia, when a continuous flow machine is used,unless When an intermittent type of machine is used, the patient has tobe told by the doctor to breathe through the mouth. The presentinvention controls analgesia without the adjustment of any parts orvalves at the inhaler or mask, and control can be had entirely by thepatients own effort.

In the present device no double tube connection to the inhaler isnecessary, but only asingle tube of relatively large diameter. Inoperating the device, the patient does not grip any part of the inhalertube. In fact, the hand which operates the device may rest onthe arm ofthe chair and is always well below the operating zone so that thepatient cannot interfere in any way with the operation, as is likelywhen he has to raise his hands to the inhaler to adiust a valve.

Another advantage is that with the present device the patient will not-move the mask or Difierent persons react quite differently to theadministration of an anesthetic and in addition, a proper state ofanalgesia is more diflicult to maintain in one person than another. Mostpersons are afraid to breathe such substances because of a feeling ofsuffocation and they always feel more secure when they believe they\have such a control as will enable them to get air when they want it.On the other hand, the patients judgment as to the quantity of analgesicsubstance required is not always sound and when this is so, the doctoror operator must be able to get control without letting the patient knowthat he no longer has full control. vention provides for allcontingencies.

[It will-be noted that the orifice or tube fo attachment of the bag isplaced between the point of delivery of the anesthetic substanceinto'the chamber, and the air intake opening and with. this arrangement,there is no'pressure on the bag or in the breathing line when deliveryof the analgesic substance has been stopped by closure ofthe valve.Experiments have proven that pressure on the bag is not necessary, andsome anesthetists do not desire that a quick on-rush of gas take placeimmediately that the valve is opened, because this on-rush isdisconcerting to the patient. It will, of ,course, be understood thatthe gas bag can-be'placed on the machine at the opposite side or'entryside of the delivery orifice.

It will bejunderstood that the full hand gripping scheme is claimedbroadly herein, whether the trigger grip be applied to a memberwhich'can be swung and swiveled, or whether it be applied to the arms ofa chair so that when the patient grips the arms (as he naturally doeswhen in pain), the

trigger or buttonis moved to operate the valve to obtain delivery ofmore analgesic or anesthetic substance. Of course, the whole grip ideacan be applied directly to a machine which is so placed that the patientcan reach it when in the dental or other chair. plied on a bed,operating table, etc.

In regard to a connection such as 53, or its equivalent, which permitsrelatively extensive motion of the hand of the patient relative to thebreathing line including tube and inhaler, there is no intention tolimit the invention as to the exact location of the valve means. Thisflexible connection between the gripping piece or the hand-operablemeans could be on the tube or on the inhaler, but under such conditions,and with the present invention, the patient can move the arm relativelyextensively, while maintaining the gripping control. In this device, theconstricting action of the whole hand including the thumb is used, asdistinguished from the pressing of a button or lever which is at the endof an element which, is gripped by the remaining fingers.

The words breathing line as used herein-are which the patient draws.anesthetizing gas or vapor or air or both, or oxygen, after such gashas been delivered from; the machine.

'Another feature of the invention is the idea of by-passing withoutpatient control, or without the -use of valve means other than thatnecessary to the breathing line. Another feature is by-passdeliverythrough the delivery passage of the may chine. 1

The present in- Moreover, this idea can be ap- The timer can operate, infact generally; does operate, while the patient is'tightly gripping theautomatic-pistol-like grip, so that the patient is unaware that he nolonger has control of the anesthetizing substance. On the other hand, ifthe trip HD is adjusted so that it will not be engaged,

by the element I09, timing can still be obtained if the patient releasesthe grip, and the timing period can be extended or lessened. When thetrip Ill! is in position to trip, and. during timing, the patientreleases the grip and tightens it again, an d re-starts the timer, thusextending the time. nutomatictiming only takes place when the trip isoperative. When the trip is not in operative position, and as thepatient releases his grip, the

various springs in Figure 9 act to move the elements 4%, 9i and H6 indirection opposite that shown by the arrows. Thus timing can becontrolled by the patient, or independently ofthe patient. Moreover,timing can be used with or without by-passin'g, and by-passing can beused V to assume closed position. Nevertheless the valve 522, when it isused, is only allowed to snap to closed position when lit closes valve65. In the form of Figure 3, both valves 65 and 66 are snapped 'toeither open or closed position after the valve 66 passes a vertical linepassing through pivot 69.

Although I have disclosed means for obtaining graduated rebreathing, seeelements ltd, 56!, I68, Figure 1, it will be understood that a chamberthe equivalentof that shown can be used, without the volume-variationfeature. Another feature is the use of gas conserver so positioned thatthe air is drawn therethrough', but so related to the rebreathing bagthat one only is used at a time, whatever the position of the bag. Incase the bag is at that side of the delivery valve opposite that shownin Figure 3, then when valve .65 is opened, air passage 36 is closed,and the patient can breathe. in the bag, 'but not through the airopening, and when valve 65 is closed, passage 36 is opened to thepatient, and bag is not open to the patient.

Another feature relates to the production of an anesthetizing machineincluding gauges 26, for indicating the relative volumes ofthe gases tobe mixed, with means for separately delivering one or a number of suchgases in a manner not to afiectlxthe gauges, including a valve which hasgraduat 'ons by which it ispossible to regulate the volume of thisby-passed gas, relative-to the readings of the gaugesitojobtain a knownvolume or quantity'of by-passedgzis} 0 ases, or mixture of such gases.One .of thesejvalvesj' is showniat 92 in Figure-2, and its graduationsare shown a t-a2 wheiithegauge hand is set at a certain position, the

amountof gas delivered by the direct valve is known measurable andvariable. In this way, when analgesia or anesthesia; is being, c on-.

trolled by anesthetizing. substances from"I two source's, one oftheqsubstances beingby-passed,

it isdesirable that the relativevplumes be known to the operator. r

I-"claimas my invention:

inhalation-- fluids, a breathing tube attached In'combination witha'machine. for deliverto the machine and having a mask, valve forcontrolling delivery of fluid from the machine into the tube, automaticmeans for closing said valve and means separate from the breathing tubeand mask attached directly to the machine and adapted for swingingadjustment and having a movable element thereon operable only by acircumscribing or grasping action of the entire hand of a patient, toopen said valve when rasping is completed, and operable when ing actionceases to permit instant closure of said valve by said automatic meansto stop. delivery.v

2. In combination with a machine for delivering inhalation fluids, acasing providing a chamber into which the fluid is delivered from themachine, said chamber having an air inhaling and exhaling passage, andhaving a passage through which fluid delivery is made into the chamber,a breathing tube for the patient communicating with said chamber andhaving a mask applicable to the face of a patient, valve meansassociated with the chamber for controlling said passages toautomatically close the delivery passage andopen the air passage whenmoved to one position, and to open the delivery passage and close theairpassage when moved to another position, and means operable bytranslation by a positive action of a patient to move'the valve means toopen the delivery passage, and means by which said patient-operablemeans can be translated to aposition to releasablylock the valve meansin a position to open the fluid delivery passage and close the airpassage.

3. In combination with a machine for delivering inhalation fluids, anelongated breathing tube for the patient attached by one end to themachine, valve means at the machine and between the machine and the tubefor controlling delivery of the fluid from the machine into the tube,and automatically operable to stop delivery, and elongated swinginglyadjustable means directly connected by one end to and made a part of themachine and having at the opposite end a movable element thereonoperable only by the grasping action of the whole hand of a patient forcontrolling said valve means for obtaining and maintaining deli-very offluid.

4. In combination with a machine for delivering inhalation fluids, abreathing tube for the patient, a quickly self-closing valve controllingdelivery of the fluid from the machine into the tube, means operable atthe will of the patient by a sustained positive action for moving thevalve to and holding it in open position and for allowing the valve toquickly close when such positive action ceases, and means whereby fluidcan be delivered directly into said breathing tube forwardly of saidvalve in direction of the patient, independently of saidpatient-controlled valve means and operative position thereof.

5. In combination with an apparatus for delivering inhalation fluids, abreathing line into which the fluid is delivered from the machine, a

valve for controlling delivery of fluid into the 1 line, and means forautomatically closing said valve? means for controlling said valve toretard theclosure thereof, means by which the valve can be controlled bya patient independently of or-in conjunction with. said retarding means,in-

eluding means by which the patient-controlled means'can act to open thevalve and initiate a timing operation and thereafter allow the timing v6. In combination with an apparatus for ad-' ministering inhalationfluids, a breathing line for for'controlling the delivery of fluid intothe line, means for retarding valve closure, means operable by thepatient to automatically couple with said valve means for opening thesame and conciitioning the retarding means for retarding-action, andmeans for automatically uncoupling said means to initiate retardingaction, said means being capable of recoupling during the retardingaction.

'7. In combination with an apparatus for administering inhalationfluids,- a breathing line for the patient into which the fluids aredelivered, 'a valve for, controlling the delivery of fluid to the line,and timing means for retarding valve closure to shut ofi the supply,means operable by the patient and capable of coupling and uncouplingwith the timing means, and for coupling with the timing means to set thetimer-and for releasing the timing means after setting, said means beingcapable of recoupling to re-set the timer during the timing period, andmeans by which the timer can be rendered inoperative so that the patienthas full control of said valve means.

8. In combination with a machine for administering inhalation fluid, acasing providing a chamber having a passage connecting with a deliverypassage of the machine, a breathing line connecting with the chamber, avalve for controlling delivery of fluid through the passage into thechamber, means for controlling said valve including a stiff tube andmeans connecting it to the casing for universal motion, an elementtranslatable in the tube and connected to control the valve means, andan automatic pistol grip rigidly attached to the tube, and having aleverpivoted thereto and attached to the translatable element, said leverbeing adapted to be encircled by a hand applied to the grip and to bemoved as a result of grasping action of the hand.

9. In combination with an apparatus for administering inhalation fluids,including plural sources of fluid supply, means for mixing fluids fromsaid plural sources, a passage into which the 'versa, means by which thepatient controls said valve means, and a passage leading directly fromone source of fluid supply and delivering into the breathing lineforwardly of said valve means in direction of delivery to the patient.

. 10. In combination with an apparatus for delivering inhalation fluidincluding a source of fluid supply, a breathingline in connection with,the source, a breathing bag in connection with the line, an inhalingand exhaling air port in connection-:with the line -[secondary rebreathing chamber connected with the air port, for causing the patientto rebreath exhaled fluid mixed with air, and open to the atmosphere ata point remote from its connecting point, and valve meanssimultaneously'operable when moved in one direction to stop delivery offluidtothe bag and'permit air entry to the line, and stop fluid deliveryfrom the source to the 1ine, and when moved in the opposite direction to'permlt fluid delivery. from the source tot-he line and bag, and preventair entry.

11. In combination with an apparatus for administering inhalation fluidincluding a source of fluid supply, a breathing line into which thefluid is delivered from the source, an exhaling and inhaling air portconnected with the line adjacent the source of fluid supply, and are-breathing chamber connected with the port and open to the atmosphereat a point remote from its connecting point, and valve meanssimultaneously operable to stop delivery of fluid from the source to theline and open the air port, or to start fluid delivery and close the airport.

12. In combination with an apparatus for administering inhalation fluidsincluding two passages through which the same fluid or different fluidscan flow, a breathing line for the patient with which both passages areconnected, a valve for each passage, means by which a patient can openone of the valves to obtain delivery of fluid from the correspondingpassage into the line, and

means by which this valve is automatically closed 7 when the patientceases to operate said means,

whereby two inhalation fluids can simultaneously flow to the breathingline and whereby the flow of one fluid can be started or stopped by apatient, while the other is flowing.

13. In combination with an apparatus for administering inhalation fluid,a breathing line for the patient, an automatically closing valve forcontrolling flow of fluid from the apparatus to the breathing line,manual means movable to a certain position by a positive action on thepart of an operator to open the valve, means by which closure of thevalve can be delayed for a predetermined time following such positivevalve opening action by the operator, and means by whichthe valve can,accomplish its'delayed closure independently of said manual means, andwhile said manual means is in the position assumed to obtain opening ofthe valve.

14. In combination with an apparatus for administering inhalation fluid,a breathing line for the patient, an automatically closing valve forcontrolling flow of fluid from the apparatus to the breathing line,manual means operable from a point remote from the apparatus by apositive action on the part of a patient to open the valve,

means by which closure of the valve can be delayed for a predeterminedtime following positive while said positive valve-opening action by thepatient on said manual'control means continues.

15. In combination with a machine for delivering inhalationflpids, abreathing line .forthe patient in operative connection with the machine,

, means for controlling delivery of fluid from the machine to thebreathing .line including a valve and means for timing the valve toclose and stop .fluid delivery, means operable by a positive actionaction to obtain valve closure, when positive action on'the part of thepatient is completed following coupling action.

16. 'In combination with a machine for delivering inhalation fluid, abreathing line" for the patient in operative connection with'themachine,

means adjacent the. machinefor controlling demachf.ne, and

livery of fluid from the machine to the breathing line, including avalve and means for automatically moving it to close and stop delivery,means remote from the valve and operable by a positive action on thepart of a patient for opening thea fluid inlet passage communicatingwith the de.

livery line of the machine and which, when open, is in freecommunication with the breathing line passage across the chamber, saidcasing having an air passage also in free communication with thebreathing line across said chamber, valve means adapted to automaticallyclose the inlet and open the air passage for inhaling and exhaling whenmoved in one direction, and when moved in the opposite direction to openthe inlet and close the air passage to prevent inhalation of air andsaid means having a part which is swingingly connected with the casingsaid swingingly connected part having a part movable thereon andoperable only as a result of continued grasping action of the Whole handof a patient, without muscular action except that of the hand, to movethe valve means to and hold the same in position to obtain delivery ofthe inhalation fluid to the breathing line passage, and so operable thatwhen grasping action ceases the valve means is allowed to automaticallymove to stop fluid delivery by the machine, and open the inhaling andexhaling air port.

18. In combination with amachine for deliv ering inhalation fluids andhaving .a fluid delivery line, a casing providing a chamber, said casingbeing attached to said machine, said casing having a breathing linepassage with which a breathing tube for. the patient communicates, andhaving a fluidinlet passage communicating with the delivery line of themachine, and further having an air passage as an inhaling and exhalingport, each of the last mentioned passages when openbeing in freecommunication with the breathing line passage across the chamber, valvemeans adapted to automatically close the inlet and open the air passagefor inhaling and exhaling when moved in one direction, and when *movedin the opposite direction to open the inlet and close the air passage,to prevent inhalation of air and means including a part remote from themachine and valve, and operable by a positive and continued action onthe part of a patient for moving the valve means to and holding the samepositioned to obtain delivery 1 of inhalation fluid, and operable whensuch positive actionceases to allow automatic operation of the valvemeans to stop fluid delivery by the machine, said casing having abreathing -line' open the inhaling and exhaling air 1 passage with whicha breathing tube for the 1 patient communicates, and havinga:fluidinlettion, and when moved in the opposite direction' to open the inlet andbag passages, and close the air passage to prevent inhalation of air,and means operable by a positive and continued action on the part of apatient for moving the valve means to and holding the same positioned toobtain delivery of inhalation fluid, and operable when such positiveaction ceases to allow automatic operation of the valve means to stopfluid delivery by the machine, close the bag passage and open theinhaling and exhaling air port.

20. In combination with a machine for delivering inhalation fluids andhaving a fluid delivery line, a casing directly connected to the machineand providing a chamber, said casing having a breathing line passagewith which a breathing tube for the patient communicates, and having afluid inlet passage communicating with the delivery line of the machineand having a bag passage, and further having an air passage as aninhaling and exhaling port, each of the last mentioned passages whenopen being in free communication with the breathing line passage acrossthe chamber, valve means adapted to automatically close the inlet andbag passage and open the air passage for inhaling and exhaling whenmoved in one directio and when moved in the opposite direction to openthe inlet and bag passages and close' the air passage, and meansoperable by a positive action on the part of a patient for moving thevalve means to and holding the same positioned to obtain delivery ofinhalation fluid, whereby when such positive action ceases, the valvemeans 'is immediately automatically moved to stop fluid delivery by themachine, and close the bag passage and open the inhaling and exhalingair port.

21. In combination with a machine for delivery of inhalation fluid,including a casing providing a chamber, a breathing line for the patientoperably connecting with the casing and chamber, means for controllingdelivery of fluid from the machine to the breathing line including atranslatable valve automatically movable to stop delivery, said casinghaving a tubular extension, a sleeve translatable upon said extension,means operable by a patient for controlling the valve, including anelement attached to the sleeve, and an element which pases therethrough'and through the sleeve and tubular extension and which isoperablyassociated with the valve, .the degree of translative motion of thevalve in opening direction being sufiicient to permit the inner end ofthe sleeve to be engaged with the outer end of the tubular extension asa stop to lock the valve in open position, whereby by grasp- IliO ingthe sleeve and pulling it, the valve can be latable valve automaticallymovable to stop delivery, said casing having a tubular extension, a

sleeve translatable upon said extension, a stiff tube, flexible tubularmeans, attaching one end of the stiif tube to the sleeve, an automaticpistol grip attached at an angle to the opposite end of the stifi tube,and having a lever-pivoted thereto to be encircled by the hand of apatient when grasping the pistol grip, a wire passing through alltubular elements and connecting said lever with the valve fortranslating the valve from its closed position to obtain fluid delivery,the degree of motion of the valve in opening direction being suflicientto permit the inner end of the sleeve to be engaged with the outer endof the tubular extension as a stop, to lock the valve in open position,whereby by pulling on the sleeve and translating it, the valve can bepulled to and locked in open position.

23. In combination with a machine for mixing and delivering inhalationfluids including a casing providing a chamber in operative connectionwith the fluid supply of the machine, a breathing line for the patientin communication with the chamber, a valve automatically movable toinstantly stop fluid flow from the machine to the chamber, meansoperable by a positive action on the part of a patient to move the valveto obtain fluid flow, means for by-passing a fluid or fluids from themachine directly into the patient breathing line around said valve andremote therefrom, including a by-pass tube within the breathing linedelivering axially in direction of fluid flow to the patient at a pointforwardly of the valve, and tubular elements connected to said casingand delivering directly into said by-pass tube, and a valve for eachtubular element for controlling and indicating the amount of the flow.

24. In combination with a machine for delivering inhalation fluids, acasing providing a chamber, a breathing line for the patient inoperative connection with the chamber, means carried by the casing forcontrolling delivery of the fluid from the machine to the chamberincluding an automatically closing valve, a stiif tube, flexible tubularmeans attachingione end of the tube in operative relation with thecasing, an automatic pistol grip attached at an angle to the oppositeend of the stifi tube and including a lever pivoted thereto to beencircled by the hand of a patient as the pistol grip is grasped, and awire passing through all tubular elements and connecting said lever withthe valve for moving it to obtain delivery of fluid, when the lever ismoved as a result of grasping action.

25. In combination with an apparatus for delivering inhalation fluids, abreathing line in operative relation with'the apparatus, a first valvefor controlling flow of fluids from the apparatus to the breathing line,movable means controlling the'flrst valve, manually operable means formoving said movable means to valve-open position and thereafterpermitting independent motion of said movable means to valve-closingposition, means by which said movable means is moved in valve-closingdirection at a governed speed, means by which non-anesthetic fluid canbe introduced into the breathing line, a second valve controllingadmission of such fluid to said Conducting means independently of saidfirst valveand adapted to open automatically, means operable by saidmovable means when opening the first valve to close said second valve,means for releasably holding the second valve in closedposition duringvalve-closing motion of the movable means, and means by which themovable means releases the holding means during motion of the movableelement to close the first valve,

which said element is moved at a governed speed to close the valve,means by which said movement of said element to close the valve can beindependent of manually operable means to close the valve, means bywhich non-anesthetic gas can be conducted to the organs, valve meanscontrolling admission of the non-anesthetic gas to said conductingmeans, means independently opening said last mentioned valve, means forreleasably holding said valve in closed position so that it remainsstationary during the movement of the movable element to stop delivery,said movable element being adapted to contact said holding means torelease the same to permit said independent means to close it, movementof the movable means and the last mentioned valve being independent ofthe manually operated means.

27. In combination, a machine as the source of supply of a suitableinhalation fluid or fluids, and means to obtain a predetermined mixtureof the fluids, a breathing line, a breathing bag, a casing providing asingle chamber having passages communicating respectively with thesource of supply of fluids after mixing, the bag, the breathing line,

' and the atmosphere, valve means automatically movable to a' positionto close the supply and bag passages and open the atmospheric passage,means operable only by a prehensile or constrictive gripping action ofthe whole hand of a patient for moving the valve means to and holding itin a position to open the supply and bag pasdelayed closure of saidvalve means to close thefiuid supply passage including means operable bysaid patient-operable means ,to automatically couple with said timingmeans when gripping ceases, and thereafter on complete re-gripping tomove the timing means to starting position, and

means for automatically uncoupling said coupling means after completeregripping to allow timing action, said means beingadjustable to preventuncoupling action, and means for rendering the timer inoperative.

28. An apparatus for producing dental analgesia and preventinganesthesia comprising, a

machine supplying inhalation fluid, a mask for r the patient, abreathing, tube operably connecting said mask with the machine, quicklyselfclosing valve means for controlling flow of inhalation fluid fromthe machine to the mask including a valve ,casing, patient-operablemeans for controlling said valve means including a tubular memberattached to the valve casing and havingmeans adapted when squeezed bythe patients hand to move said valve means to obtain and maintain fluidflow to the mask while squeezing continues, and to operate said valvemeans to stop flow when squeezing ceases, said tube being freely movablerelatively to the casing to permit the hand-operable means to be freelymoved and be placed in any convenient position to be continuously held,and so as to be held and operated without any muscular action other thanrequired for moving the fingers, whereby the handoperable means canconstantly remain in the hand, or can constantly rest by gravity in thepalm, and whereby the entire arm can constantly assume a restfulposition, as in the lap or as on the arm of a chair.

29. In combination with an apparatus for administering inhalationfluids, means by which flow of fluid to the organs of respirationiscontrolled including a casing and a quickly self-closing valve therein,patient-operable means for controlling the valve to quickly open andclose it including, a part adapted to be squeezed by the patients handto open .the valve, and hold it open, and adapted to allow the valve toclose when squeezing ceases and including a tubular operating connectionbetween the hand-operable means and said casing of a character and ofsufficient length to permit said hand-operable means to be swung andplaced in any convenient position to be continuously held, and to beoperated, all without any muscular action other than that required formoving the fingers.

30. In combination withan apparatus for administering inhalation fluid,means by which flow of fluid to the organs of respiration is controlledincluding a valve, manual means operable by the patient to open and holdthe valve open,

and means by which the valve can accomplish its closure independently ofsaid manual means and while said valve opening action by the patient onthe manual control means continues.

31. In combination with arr-apparatus for administering inhalationfiuid, a breathing line for the patient, an automatically closing valvecontrolling fiow of fluid in the breathing line, manual means operableby a-positive action on the part of the patient to openand hold thevalve open, and meansby which the valve can accomplish itsclosure-independently of said manual means and while said positivevalve-opening action by the patient on the manual control meanscontinues.

.1 32. In combination with an apparatus for ad ministerlng inhalationfluids, means by which flow of fluid to the organs of respiration iscontrolled including a valve, a, reciprocable control element for thevalve, two springs operably connecting the control element with thevalve and so arranged as to be alternately tensioned by the controlelement respectively to open and to close the valve, one spring toremain tensioned to hold the valve in the given position, one of thesprings being de-tensloned when and while the other is tensioned, and aspring for separately moving the reciprocable control element invalve-closing direction. I 4

33. In combination antapparatus for administering inhalation fluids,-means by 'which flow ofdluid to the organs of respiration iscontrolledincluding a casing and a' valve therein, a reciprocablecontrolelement 'for the valve, two

springs operablyconnecting'the control element with the valveto bealternatelytensioned respectively to open and to close the valve, onespring to remain tensionedto hold the valve in the given position, oneof the springs being de-tensioned when and while "the other istensioned, a spring for separably moving the reciproca-ble controlelement in valve-closing direction, and means for operating thereciprocable control element, including a part adapted to be squeezed bythe patients hand to put one of the springs under tension and open thevalve, and to maintain the valve in open position while squeezingcontinues, and to allow the other spring to close the valve and hold itclosed when squeezing ceases and a movable operating connection betweenthe hand operable means and said casing of suin'cient length to permitsaid hand-operable means to be swung and placed in any convenientposition to be continuously held, and to be operated, all without anymuscular action other than that required for moving the fingers.

34. In combination with an apparatus for administering inhalation fluid,means by which flow of fluid to the organs of respiration is controlledincluding a casing having a quickly self-closing valve therein, meansforcontrolling the valve to quickly open and close it, said means havinga means operable by the patients hand, said valve controlling meansincluding a tubular operating connection between the hand-operable meansand the casing of a character to permit 1 said hand-operable means to beadjusted and trolled including a casing having a quickly selfclosingvalve therein, means detachably securing the casing to said apparatus,means for control ling the valve to open and close it, said means havinga means operable by the patientshand,

said valve controlling means including a swingable tubular operatingelement between the handoperable means and the casing of a character topermit said hand-operable means to be adjusted and placed in anyconvenient position relatively remote from the casing so as to be heldand operated without any muscular action other than that required formoving the fingers whereby the entire-arm can constantly assume arestful relaxed position as in the lap or as on the arm of a chair, withthe hand-operable means disposed for instant operation.

36. In combination with an apparatus for administering inhalation fluid,a breathing line for the patient, a casing having therein a quicklyself-closing valve for controlling flow of fluid to the patient throughsaid line, patient-operable means for controlling the valve including apart operable by the hand only of the patient without motion of the armand therefore while the arm can constantly remain in a restful position,and an elongated tubular element through which control power istransmitted, said tubular element acting to connect said part with saidvalve casing and being adapted to allow said part to be swinginglyadjusted to any position convenient to the patient.

anesthetizing machine comprising means for producing a mixture ofanesthetizing WALTER R. HENION.

